IMHLINKAN IMH QUARTERLY NEWSLETTER FOR PARTNERS

2017OCT - DEC

To raise awareness and reduce stigma around mental health issues, 25 partners from the private, social and government sectors came together to organise a concert in the park on 7 October. Held in conjunction with World Mental Health Day, the Voice Out concert at the Singapore Botanic Gardens saw more than 3,000 attendees brave the rain to support the mental health cause.

The concert featured local singers Stefanie Sun, MarcXHashy, Amanda and Chloe Seah who recounted their mental health struggles and how they overcame their challenges. Conversations also happened off-stage during the Human Library* activity where concert-goers “checked out” 11 “human library books”. The mental health advocates (“human books”) had the opportunity to interact with participants, share their lived experience, debunk myths and spark conversations around mental health.

“Persons living with mental illness face challenges such as social isolation and discrimination as they are often stereotyped as being incompetent, unpredictable and even dangerous. When such

discriminations are internalised, these persons start to develop self-stigma which hinders them from reaching out for help,” said A/Prof Chua Hong Choon, CEO, IMH. “We need to break this cycle by coming forward to talk about mental illness.”

The concert ended on a high note with a group of singers – comprising a psychiatric nurse, a caregiver, a person in recovery, a mental health advocate and a youth volunteer – singing the theme song “Voice Out”. Released in early September, the song is about encouraging one another to speak up about problems, lend a listening ear and celebrate mental wellness. It was written specially for the event by local songwriter Jack Lim, and general practitioner Dr Joel Foo and his young daughter.

* The Human Library �rst started in Denmark in 2000 and is a worldwide movement for social change that is designed to challenge stereotypes and prejudices through dialogue. Visit http://humanlibrary.org/ for more info.

1. Guest of honour Mr Baey Yam Keng, Parliamentary Secretary for Culture, Community and Youth, on stage with the Voice Out singers, A/Prof Chua Hong Choon, CEO, IMH and Dr Tan Weng Mooi,Chief of Community Mental Health Division, Agency for Integrated Care. 2. Husband-wife duo MarcXHashy performing their original compositions. 3. Mental health advocate Chia Xun An engaging participants and sharing his recovery story. 4. Mandopop Queen Stefanie Sun wowing the audience with her hit songs.

Voice Out against Stigma

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A study conducted by IMH Research Division has found that women in Singapore have a 7.2 per cent lifetime prevalence of major depressive disorder (MDD), compared to 4.3 per cent among men.

Published in the November issue of the Singapore Medical Journal, the study was based on data collated from the Singapore Mental Health Study, which was conducted from 2009 to 2010 on 6,616 Singaporeans and permanent residents.

“This gender gap, which is consistent with results from similar studies done in other countries, could be due to a number of factors. These include hormonal mechanisms as well as social and cultural in�uences, such as the dual roles that many women take on at home and at work. Women are also more likely and more open to seeking help,” said A/Prof Mythily Subramaniam, Director, Research Division, IMH, who is one of the �ve co-authors of the study.

Women between 18 and 34 years old were found to be more likely to suffer from MDD compared to those belonging to older age groups. The study also found that women with less education i.e. those with up to primary school level, had a lower risk of MDD than those with university-level education.

“We ought to raise greater awareness among the community that sometimes when females are behaving in an ‘emotional’ manner, there could be a physiological cause. It may not be something that they can easily ‘snap out of’,” A/Prof Mythily added.

Study Finds Women are More Prone to Depression than Men

I remember being very particular about cleanliness as a teenager. I didn’t think it was something to be concerned about since it did not affect my life adversely.

When I was retrenched in 2003, things became worse. I was 24 years old then. I could not stop crying and felt very fearful for unknown reasons. I saw several general practitioners and was subsequently referred to a specialist where I was diagnosed with depression and obsessive compulsive disorder (OCD).

My OCD symptoms were fear of contamination, obsession with arranging things in a particular order, and compulsive counting and checking. I spent hours cleaning the house and washing the toilet daily. I feared and resisted going out because it meant more cleaning and wiping when I return home. Due to my OCD, I set "rules" for my family to follow, which frustrated them and caused problems at home.

I stopped taking medications as it aggravated my gastrointestinal problems and I eventually

stopped seeing the doctor. My condition worsened and at the lowest point in my life, I spent about seven hours cleaning the toilet daily. I did not step out of the house for four months and had to get my mother or sister's help to buy food and other daily essentials. I was trapped at home and my whole life turned upside down.

I could no longer take the stress of living this way and resumed my treatment in 2014. I went for Exposure and Response Prevention therapy (ERP) which required me to perform tasks that I fear and avoid, such as pressing the lift button and throwing rubbish. With therapy, I can now perform these tasks without much distress and can function at a reasonable level.

Looking back, I am thankful to have come this far. I am now working as a peer support specialist and support other patients in recovery by sharing my own lived experience. I credit my recovery to my mother who stood by me throughout my lowest moments.

MY SAY

Overcoming My Crippling ObsessionBy: Grace (pseudonym)

Making a Difference in the Lives of Long-stay PatientsIMH is home to over 1000 long-stay patients. Volunteers play an important role in normalising the lives of these patients by spending time with them, and giving them an opportunity to socialise and build friendships. There are about 400 regular volunteers with IMH, coming from all walks of life and include students, working adults, retirees and housewives. They engage patients in meaningful social, recreational, and leisure activities to improve their mental and physical well-being.

The Achievers, one of the longest running volunteer groups with IMH, was awarded the Singapore Patient Action Awards (SPAA) in the Volunteer Group category at the Singapore Patient Conference 2017 on 20 October. The SPAA recognises caregivers, volunteers and volunteer groups for their efforts in enhancing the quality of lives of patients in Singapore.

The Achievers have been volunteering at IMH for 17 years. Comprising mainly working adults, the group holds various activities such as monthly birthday celebrations, festive celebrations and outings to places of interest. They also organise a monthly bazaar to sell merchandise such as paintings and cards made by IMH patients, and items and clothes donated by the public with the proceeds going to the Woodbridge Hospital Charity Fund. The

stalls are run by selected long-stay patients and over time, the experience helps them build various skills and self-con�dence.

“We want to do our part to further the mental health cause,” says Mr Yong Kwon Seng, from The Achievers. “Through our volunteer work, we hope to provide companionship to patients and at the same time be the voices, change agents and champions for them.”

Supporting Patients’ Reintegration into the CommunityThe Sin Ming-Ang Mo Kio (SM-AMK) Aftercare Programme was rolled out in 2015 after a successful one-year pilot. The programme aims to provide case management support for patients with high social needs, after they are discharged from IMH back into the community.

To help patients during this transition, the IMH case manager (CM) works collaboratively with community partners in co-managing and caring for patients living in the Sin Ming vicinity. This entails joint home visits by the CM and the community partner to assess patients in their home environment.

Each case is reviewed every six months. If the patient is stable, the community partner will take over his care. Being on the ground engaging the patients where they live, community partners are well-placed to recognise signs of relapse in patients, and communicate their observations to the CM for intervention to manage early relapse. As a Single Point of Contact (SPOC) from the tertiary setting, the CM also facilitates a smooth �ow of information and service link-up with the community partners.

The SM-AMK Aftercare Programme has helped to reduce patients’ readmission rates, emergency room visits, and defaulted appointments. Patients involved in the Aftercare Programme were also observed to have become more compliant to their medical appointments. Seeing these encouraging outcomes, the Aftercare Programme was extended to the Kembangan Chai Chee region and the Kreta Ayer-Henderson region in 2017, with another two CMs working closely with community partners within these regions.

Since the beginning of the pilot phase, IMH Senior Case Manager Gemma Angela Fernandez has been supporting the SM-AMK Aftercare Programme as the SPOC. For going the extra mile to support and engage her patients, Gemma received the Silent Heroes Outstanding Adult Award and the NHG Excellence in Action Award (Individual) this year. Her sel�ess efforts included making home visits outside of of�ce hours, purchasing groceries for patients and refurbishing their homes to ensure they are well-settled. Senior Case Manager, Gemma Angela Fernandez with her

patients at the void deck of their block.

The Achievers with A/Prof Chua Hong Choon, CEO, IMH (second row, centre).

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When does drinking become a problem? Some signs that drinking is becoming a problem for the individual include knowingly using alcohol in situations where it is physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctor’s orders. The person may also continue to drink even though the alcohol use is affecting his relationships with others, and is having a detrimental impact on many areas of his life including health and employment.

Should one go cold turkey to stop the addiction? Persons who are dependent on alcohol will suffer from withdrawal symptoms when they stop drinking – some of these symptoms can be severe and distressing. As such, going cold turkey is not recommended for those who may have moderate to severe alcohol problems. In fact, for some individuals with pre-existing medical problems, going cold turkey can be life threatening. They may experience reactions like seizures, which require medical attention. It is pertinent that they see a doctor �rst when they plan to cut down or stop alcohol use.

Treatment depends of the severity of the condition and the individual’s needs. It could involve an inpatient detoxi�cation programme or a comprehensive outpatient programme with medication and counselling.

What do you do if you or someone you know has a problem with alcohol?If you or someone you know has a problem with alcohol, encourage them to seek help. Call the All Addictions Helpline at 6-RECOVER (6-7326837) for advice on services and help available.

Family members and friends play an important role in the individual’s recovery. Show him your support and concern without scolding, belittling or blaming the individual, as this may make him defensive and is generally unproductive. Be involved in his recovery journey, perhaps by attending some of the counselling or therapy sessions with him, and be patient if there are relapses along the way.

AdvisorTing Mei See

Circulation CoordinatorChris Ngiam

EditorLalitha Naidu

DesignerNg Yee Choo

EDITORIAL TEAM

ContributorsHannah Huang, Case Management UnitPenny Chua, Corporate CommunicationsVera Soo, Corporate Communications

Sum Foong Yee, Corporate CommunicationsFiona Foo, Corporate Communications

Season’s Greetings! Institute of Mental Health, Singapore t (65) 6389 2000 | f (65) 6389 2986 | www.imh.com.sg | enquiry@imh.com.sg

Alcohol has a place in social, cultural and family traditions for many, especially during the festive season. But when use of alcohol becomes unhealthy and it starts to affect your daily life, it’s time to seek help.

How much drinking is too much?Experts generally recommend keeping alcohol intake to a minimum. It is safest to avoid alcohol altogether if you are on medication that can interact with alcohol, if you are pregnant, have pre-existing medical conditions that can be made worse with alcohol use, or if you are a recovering alcoholic.

If you do plan to drink alcohol, the general recommendation is that a healthy individual should not consume more than two standard alcoholic drinks for women and not more than three for men per day. If you are driving or operating machinery that could cause injury, you should not drink at all.

A standard alcoholic drink contains 10 grams of alcohol, and this can be estimated to be:

• 1 can (330 ml) of regular beer• Half glass (100 ml) of wine• 1 nip (30 ml) of spirit

What is alcohol addiction? Alcohol addiction is a chronic, progressive and relapsing illness that involves the compulsive use of alcohol despite adverse consequences. Individuals with an alcohol addiction will typically show some or most of the following features within a 12-month period.

• Being unable to stop or limit the amount of alcohol they drink • Feeling a strong need or compulsion to drink • Developing tolerance to alcohol so they need to increase consumption in order to feel its effects • Experiencing physical withdrawal symptoms such as nausea, sweating and shaking when they don't drink • Becoming annoyed when their daily ritual of having a drink is disrupted or questioned• Getting agitated easily, and feeling anxious or uneasy when they don’t drink• Spending inordinate amounts of time thinking or planning to have their next drink and recovering from the after-effects of drinking

When Drinking Becomes a Problem Mr Viknesan, Senior Counsellor, National Addictions Management Service, IMH

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